Provider Demographics
NPI:1750962486
Name:RIVERA, MILLICENT YAHAIRA
Entity type:Individual
Prefix:MRS
First Name:MILLICENT
Middle Name:YAHAIRA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MUSTARD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-6980
Mailing Address - Country:US
Mailing Address - Phone:585-314-2529
Mailing Address - Fax:
Practice Address - Street 1:1 MUSTARD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-6980
Practice Address - Country:US
Practice Address - Phone:585-314-2529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist